[Barriers for visiting a dental clinic among (frail) older individuals; the momentum of the influenza vaccination as finding place]. / Barrières bij (kwetsbare) ouderen voor bezoek tandartspraktijk; griepprikmomentum als vindplaats.

As age increases, the proportion of older people visiting a dental practice decreases. The aim of this survey was to gain insight into the extent to which frailty and/or dental status are related to visiting a dental practice and what barriers older (frail) people experience in this respect. A questionnaire was distributed among people eligible for the annual flu vaccination in Winschoten, The Netherlands. In total, 1027 people aged 60 and over completed the questionnaire. 60-80% of them had recently visited a dental practice depending on their frailty. Dental status was the decisive factor for not visiting a dental practice. Edentulous individuals were more likely not to visit than (partially) dentate individuals. Barriers to visiting a dental practice were related to making an appointment, costs, and/or the services provided. The flu vaccination seems to be an interesting momentum to identify people who do not, or no longer, visit a dental practice.

[Updated indications and contraindications in 2022 for lung transplantation in France]. / Transplantation pulmonaire en France : actualisation des indications et contre-indications en 2022.

Lung transplantation (LTx) is the last-resort treatment for end-stage respiratory insufficiency, whatever its origin, and represents a steadily expanding field of endeavor. Major developments have been impelled over the years by painstaking efforts at LTx centers to improve donor and recipient selection, and multifaceted attempts have been made to meet the challenges raised by surgical management, perioperative care, and long-term medical complications. The number of procedures has increased, leading to improved post-LTx prognosis. One consequence of these multiple developments has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. With these considerations in mind, the Francophone Pulmonology Society (Société de Pneumology de Langue Française [SPLF]) has set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force has examined the most recent literature and evaluated the risk factors that continue to limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.

Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7-9 years of age: a longitudinal study.

PURPOSE: The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. METHODS: The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18-22 and 32-36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. RESULTS: Among the children (7-9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18-22 and the number of affected teeth among those with MIH at 7-9 years (adjusted RR = 1.82, 95% CI 1.13-2.93). CONCLUSION: Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7-9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

Response of diamond detectors in ultra-high dose-per-pulse electron beams for dosimetry at FLASH radiotherapy.

Objective.With increasing investigation of the so-called FLASH effect, the need for accurate real time dosimetry for ultra-high dose rates is also growing. Considering the ultra-high dose-per-pulse (DPP) necessary to produce the ultra-high dose rates for investigations of the FLASH effect, real time dosimetry is a major challenge. In particular, vented ionization chambers, as used for dosimetry in conventional radiotherapy, show significant deviations from linearity with increasing DPP. This is due to recombination losses in the sensitive air volume. Solid state detectors could be an alternative. Due to their good stability of the response with regard to the accumulated dose, diamond detectors such as the microDiamond could be suitable here. The aims of this work are to investigate the response of microDiamond and adapted microDiamond prototypes in ultra-high DPP electron beams, to understand the underlying effects and to draw conclusions for further detector developments.Approach.For the study, an electron beam with a DPP up to 6.5 Gy and a pulse duration of 2.5µs was used to fulfill the conditions under which the FLASH effect was observed. As a dose rate-independent reference, alanine dosimeters were used.Main Results.It has been shown that the commercially available microDiamond detectors have limitations in terms of linearity at ultra-high DPP. But this is not an intrinsic limitation of the detector principle. The deviations from linearity were correlated with the series resistance and the sensitivity. It could be shown that the linear range can be extended towards ultra-high DPP range by reducing the sensitivity in combination with a low series resistance of the detectors.Significance.The work shows that synthetic single crystal diamond detectors working as Schottky photodiodes are in principle suitable for FLASH-RT dosimetry at electron linear accelerators.

Forecasting brain activity based on models of spatiotemporal brain dynamics: A comparison of graph neural network architectures.

Comprehending the interplay between spatial and temporal characteristics of neural dynamics can contribute to our understanding of information processing in the human brain. Graph neural networks (GNNs) provide a new possibility to interpret graph-structured signals like those observed in complex brain networks. In our study we compare different spatiotemporal GNN architectures and study their ability to model neural activity distributions obtained in functional MRI (fMRI) studies. We evaluate the performance of the GNN models on a variety of scenarios in MRI studies and also compare it to a VAR model, which is currently often used for directed functional connectivity analysis. We show that by learning localized functional interactions on the anatomical substrate, GNN-based approaches are able to robustly scale to large network studies, even when available data are scarce. By including anatomical connectivity as the physical substrate for information propagation, such GNNs also provide a multimodal perspective on directed connectivity analysis, offering a novel possibility to investigate the spatiotemporal dynamics in brain networks.

[The oral health of frail home-dwelling elderly in the general practice]. / De mondgezondheid van kwetsbare thuiswonende ouderen die de huisarts bezoeken.

The number of frail home-dwelling elderly is increasing, and they are likely to retain their own dentition longer when ageing. With increasing age, the number of dental visits declines, while the number of visits to the general practitioners' (GP) clinics increases. The aim of this study was to assess the oral health status and dental visits of frail home-dwelling elderly that visit their GP. The study consisted of questionnaires and an oral examination. Subjective and objective oral health was determined by the Geriatric Oral Health Assessment Index-NL and the Oral Health Assessment Tool. Almost half of the frail elderly had not visited the dentist for over 2 years and a quarter had objective oral health problems. The educational level and the dental status were of influence on the dental visits and on their oral health. In about a third of the subjects, a subjective oral health problem was observed, which was influenced by the extent of the subject's frailty. A multidisciplinary approach can improve the oral health status of frail home-dwelling elderly.

[Collaboration of oral care and well-child care: for better preventive dentistry]. / Samenwerking mondzorg en jeugdgezondheidszorg; voor betere tandheelkundige preventie.

The new Dutch clinical practice guideline Oral Care for Children and Young People advises parents to visit the oral care professional before or from the eruption of the first tooth, because oral care starts with the first deciduous tooth. However, this is not yet standard for everyone. Still, almost all parents of newborns (> 95%) visit well-baby clinics with their newborn. This article describes how well-baby clinics and oral care can collaborate and how in the Netherlands, young children and their parents can be contacted earlier for (preventive) dental care. There are a few examples of projects in which well-child clinics and oral care collaborate, such as the Gezonde Peutermonden project (toddlers' healthy mouths project), the GigaGaaf project (giga whole project) and the case of a practice in Haarlem, in the Schalkwijk district. Because these projects are still in progress, it is not yet clear whether a collaboration between well-child clinics and oral care will also have an effect on the caries prevalence in children.

[18 years old: choose wisely! Provision of information about changing health insurance status]. / 18 Jaar: verstandig kiezen! Informatievoorziening rond veranderende verzekeringsstatus.

From the age of 18, dental care is no longer covered by basic healthcare insurance [in the Netherlands]. Individuals can voluntarily take out additional insurance however. The aim of this study was to map out what information those nearly 18 years old receive about the changes in coverage of dental care (Part A) and what their preferences were concerning information on this topic (Part B). Part A consisted of desk research on the websites of 4 health insurers and government agencies, complemented with interviews with portfolio holders. Part B consisted of a questionnaire survey among 18-year-old secondary school pupils training for university and vocational students (n = 106).The websites of health insurers and government agencies contained some information, 2 health insurers sent information by post about dental insurance and 1 also got in touch by phone. The level of knowledge about the insurance system among 18-year-olds was low, information often did not seem to have been received and they did not look for information themselves. Secondary school pupils training for university preferred to receive written information, vocational students preferred to receive it orally. Conclusion: Information about the changing health insurance status is available but does not reach those nearly 18 years old effectively. Cooperation and clarity on the responsibilities regarding the provision of information is recommended.

[Impact of the corona lockdown on daily oral health care behaviour of young children]. / Impact van corona-lockdown op het dagelijks mondgezondheidsgedrag van jonge kinderen.

This study explores the possible effects of the current corona pandemic and the ensuing measures on parental oral care behaviour, particularly during the lockdown period. Moreover, this study examines to what extent these effects differ according to the educational level of the parents. In total, 120 parents of children aged 4-5 years completed a digital questionnaire about parental oral care behaviour. The results show that during the coronavirus lockdown, 26% of parents skipped toothbrushing more often in the morning, 44% let their child snack more often, and 22% let their child drink sweetened drinks more often. In addition, parents with a high educational level skipped tooth brushing in the morning more often than parents with a low educational level. In contrast, parents with a low educational level skipped toothbrushing more often in the evening than parents with a high educational level. The results of this small study suggest that the coronavirus lockdown affected parental oral care behaviour.

[Kies-voor-Tanden Study: caries among 17-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 17-jarigen in Nederland.

This fourth in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 17-year-olds. 34% of the 17-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic groups, to the advantage of the high socio-economic group. The oral health of 17-year-olds had stagnated during the previous 6 years and even appeared to be deteriorating according to some indicators. In addition, knowledge about the dental insurance system after the 18th birthday was poor. Conclusion: The oral health of 17-year-olds had not improved in the previous years. This trend must be followed by monitoring research. In addition, interventions to improve the oral health, knowledge and behaviour of adolescents should be set up and evaluated.

[Kies-voor-Tanden Study: caries among 23-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 23-jarigen in Nederland.

This fifth and final in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 23-year-olds. 21% of the 23-year-olds had flawless permanent teeth. In 2017, there were still differences in oral health among the socio-economic (SES) groups, to the advantage of the high SES group. The oral health of the low SES group had shown some improvement in the previous 6 years, while this was not the case within the high SES group. The preventive dental behaviour of 23-year-olds was not optimal and the knowledge about the dental insurance system was poor. Conclusion: the oral health of 23-year-olds had partly improved, partly stagnated. Since not everyone will be able to access information through oral care professionals, other ways of providing information to them must be considered. In the context of public health, to be able to follow trends in oral health and dental preventive behaviour of (young) adults, research monitoring oral health is of great importance.

[Oral care for patients in the palliative stage of life - do you care?] / Mondzorg bij patiënten in de palliatieve levensfase ­ ook uw zorg?

In this questionnaire study, the attitude of dentists and students regarding the provision of oral care to palliative patients was investigated. The extent to which they would like to be involved in the care for this patient group was also investigated. The results showed that both research groups had relatively little affinity with palliative patients. In general, however, they do consider oral care to be important for this group and believe a dentist can play a role in the quality of life. About one third of both research groups, nevertheless, preferred not to be involved in the provision of oral care often. Besides, when it comes to providing oral care in nursing homes or at patients' homes, approximately one third of the respondents were not very willing or not willing at all to make house calls. Dentists and students are aware of the importance of oral care in the palliative stage of life, but they do not (yet) want to be responsible for the oral care themselves.

[Kies-voor-Tanden Study: the incidence of caries among 11-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 11-jarigen in Nederland.

In this third article in a series of 5 in the context of the 2017 Kies-voor-Tanden Study, the results for the 11-year-olds are presented. The study was conducted among 11-year-olds who lived in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of a clinical oral examination and a questionnaire completed by both them and their parents. Of the 11-year-olds, 61% had caries-free permanent teeth. In 2011, this percentage was 73%. In 2017, there were still differences in oral health among socio-economic groups, to the advantage of the higher socio-economic group. The conclusion is that the oral health of 11-year-olds has not improved in the last 6 years. Despite the low prevalence of DMFS, there appears to be a trend towards deterioration. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving preventive behaviour and good oral health self-care.

Acute Cardiac Failure Due to Takotsubo Cardiomyopathy Secondary to a Phone Call for Lung Transplantation: A Case Report.

Lung transplantation is a therapeutic option for certain end-stage lung diseases. The phone call for lung transplantation is a major event in the life of these patients; as a result, it can generate significant stress. We herein present the case of a 58-year-old female patient with end-stage chronic obstructive pulmonary disease (COPD) who, while on the lung transplantation waiting list, received such a call. Complete transplant work-up, including cardiac tests undertaken shortly before, had revealed no contraindication to lung transplantation. She was admitted with severe acute respiratory failure, and her extensive work-up was compatible with pulmonary edema due to takotsubo cardiomyopathy. The lung transplantation was thus cancelled, owing to the patient's health condition and the poor quality of the graft as well. The patient stayed in the intensive care unit for several days, requiring noninvasive ventilation. The left ventricular function recovered completely within 10 days postdiagnosis, and the patient was discharged 13 days after her admission. The patient was transplanted 1 month thereafter, without any particular problems; she is currently, 8 months post-transplantation, in good condition. In the given case, the call for lung transplantation could have generated emotional stress severe enough to lead to takotsubo cardiomyopathy.

[Kies-voor-Tanden Study of children and adolescents: motivation and study design]. / Kies-voor-Tandenonderzoek 2017 onder jeugdigen: aanleiding en onderzoeksopzet.

In 2017, Dutch research institute TNO carried out research commissioned by the National Health Care Institute intended to gain an up-to-date and representative picture of the oral health and the preventive dental behaviour of 5, 11, 17 and 23-year-olds in the Netherlands and to identify possible changes therein since previous measurements. Since the motivation, background, study design, material and method were identical for the 4 ages, and the same issues, to a certain extent, are to be considered in the discussion in each of a series of 5 articles, these identical and generic matters will be described in this article.Since there is no system in the Netherlands to structurally monitor oral health, these Kies-voor-Tanden studies are eminently important for following trends in oral health and preventive dental behaviour in children and adolescents over longer periods of time. Data of this kind are indispensable in formulating meaningful policy on oral health. The continuation of research monitoring oral health is therefore strongly recommended.

[Kies-voor-Tanden Study: the incidence of caries among 5-year-olds in the Netherlands]. / Kies-voor-Tandenonderzoek 2017: cariëservaring bij 5-jarigen in Nederland.

This second in a series of 5 articles in the context of the 2017 Kies-voor-Tanden study presents the results for 5-year-olds. The study was conducted among 5-year-olds living in Alphen aan den Rijn, Gouda, Breda or Den Bosch and consisted of completing a questionnaire and undergoing a clinical oral examination. 76% of the 5-year-olds had a caries-free deciduous dentition. This percentage represented an increase compared to previous research. No change was seen in children with caries experience. In 2017, there were still differences in oral health among the socio-economic groups, in favour of the highest socio-economic group. Conclusion: the oral health of the 5-year-olds seems to be moving in the right direction, but there is still a social gradient and there is still room for improvement. For risk groups, interventions to keep the teeth intact should be aimed primarily at improving behaviour and oral health self-care to prevent caries.

[Socioeconomic differences in oral health outcomes among adults in the Netherlands]. / Sociaal-economische verschillen in mondgezondheidsuitkomsten van volwassenen in Nederland.

The aim of the present study was to describe the oral health situation of the adult Dutch population in terms of caries experience and the need for periodontal treatment. The research consisted of a clinical dental examination and a questionnaire on oral health and was carried out among 25- to 74-year-olds living in Den Bosch, distinguished according to age and educational level. The group with a low socioeconomic status (SES) had more teeth affected by caries, had undergone less extensive dental treatments and were more in need of periodontal treatment than the high SES group. On this basis, it can be concluded that socioeconomic statuswas also negatively correlated to several oral health indicators in 2013. One has to consider whether the picture sketched by this study matches Dutch society's expectations.

Encapsulating genetically modified Saccharomyces cerevisiae cells in a flow-through device towards the detection of diclofenac in wastewater.

Recently it has been proposed to use sensors based on genetically engineered reporter cells to perform continuous online water monitoring. Here we describe the design, assembly and performance of a novel flow-through device with immobilized genetically modified yeast cells that produce a fluorescent protein upon stimulation with diclofenac whose intensity is then detected by fluorescence microscopy. Although other devices employing immobilized cells for the detection of various analytes have already been described before, as novelty our system allows safe enclosure of the sensor cells, and thus, to obtain fluorescent signals that are not falsified by a loss of cells. Furthermore, the yeast cells are prevented from being released into the environment. Despite the safe containment, the immobilized reporter cells are accessible to nutrients and analytes. They thus have both the ability to grow and respond to the analyte. Both in cell culture medium and standardized synthetic wastewater, we are able to differentiate between diclofenac concentrations in a range from 10 to 100 µM. As particularly interesting feature, we show that only the biologically active fraction of diclofenac is detected. Nowadays, contamination of wastewater with diclofenac and other pharmaceutical residues is becoming a severe problem. Our investigations may pave the way for an easy-to-use and cost-efficient wastewater monitoring method.